Steroid injection - looking for experiences/literature

[Antje77]

I'm having an appointment with my rheumatologist next week. Last time I saw her was over a year ago, we couldn't pinpoint a diagnosis so we agreed on waiting and seeing until next year, which is now.

A year ago, she seemed very keen on giving me a steroid injection in my knee. The knee bothered me but not to the point I wanted to risk diabetes management becoming a nightmare with a steroid injection so I declined. She was also rather dismissive of my worries about the effects on diabetes, and I have a feeling she doesn't know much about diabetes, so she's not the right person to advise me on side effects for diabetics.

By now, my knee bothers me enough to wake me up multiple times a night, and the other knee is bothering me as well, to a lesser extent.
So in anticipation of my appointment, I want to learn more about steroid injections and diabetes in case she offers me again to be able to make an informed decision.

If any of you have had such injections, how did it affect your diabetes? All experiences are interesting to me, no matter if you're diet controlled or on insulin, so don't hesitate to reply if you have a different type of diabetes than I have!
I'm particularly interested in how long the effects on BG lasts. I can deal with a couple of days of diabetes misery, a week or longer is a different story.
If anyone has links to relevant studies, very welcome as well!

I also sent my endo a message, not sure if she'll have time to reply before my rheumatology appointment.

Thanks in advance!

 

[Rachox]

I had a steroid injection in my foot around this time last year having put it off for some time due to fears about pushing blood sugars up. Turned out I needn’t have worried. Aside for the time of the injection when my blood sugar shot up due to the pain of the actual injection. I’m not going to lie it was very uncomfortable, but the Dr that did it said it was because it was a foot joint with a very small space to inject into. I guess a knee will be very different from that point of view. Anyway back to blood sugars, once the injection was finished and by the time I got home (15 mins) drive, my blood sugars were back to normal and stayed that way. It was well worth having.
I hope you can decide what to do and your knee is sorted soon x

 

[grantg]

NB Honeymooon Period: raised for a little bit ~0.5 (5.3 upto 5.8) average 2 week period following 2 weeks ~0.4 injection had was lower back. between L5 and S1 slightly to the left towards hip. NB Honeymoon period. have the libreview log if that is of use. reduced insulin doses very shortly after that. theres a few studies available mixed t1/t2/nondiabetic. dont see (although have been looking) specifically if any were on lada nor seen anything with effects honeymoon itself. 10th dec is my next painrelief injection which looking forward to.

Edited for clarity: (5.3 upto 5.8)

 

[h884]

Hi Antje77

I have had steroids injections into my hands on numerous occasions. The steroids had a very positive effect on the pain in my hands.

Unfortunately the steroids did cause my diabetes go out of my control for about 7 days. After that things began to settle down. I am a pump user. I was guided by the pump team to increase my basal rate by 10% in the first instance to deal with the rise. I eventually needed to increase it by 20%, then slowly decrease it back to where it started.

For me it was worth it as the pain in my hands was significant.

I have a good friend who has has steroid injections into her knees.she found they helped a lot. Good luck with your decision making.

 

[Melgar]

I’m interested too @Antje77 . My Dr is arranging steroid injections for my thoracic spine . I’m hoping it will be like @Rachox.

Sorry @grantg are you saying that after your steroid injection in your lumber region your blood sugars initially rose 0.5 then went down to 0.4 mmmol/ls for the following two weeks?

 

[grantg]

I’m interested too @Antje77 . My Dr is arranging steroid injections for my thoracic spine . I’m hoping it will be like @Rachox.

Sorry @grantg are you saying that after your steroid injection in your lumber region your blood sugars initially rose 0.5 then went down to 0.4 mmmol/ls for the following two weeks?

average rise is what im saying. hopefully attached is allowed screenshot from libreview (with the s/n area's removed). i can dig out the actual logs themselves if that is more useful. around day 4-5 of the very first date range was when inititally had injection. NB Honeymoon period. only diagnosed back in january. mid october 2024 was prior injection in same area have had 4 in total so far. very first one constrast dye was used unsure why the following 3 were done differently.

5.3 ave to 5.8 maybe i should of said that. Shall i edit my above post for clarity?

 

[Antje77]

Unfortunately the steroids did cause my diabetes go out of my control for about 7 days. After that things began to settle down. I am a pump user. I was guided by the pump team to increase my basal rate by 10% in the first instance to deal with the rise. I eventually needed to increase it by 20%, then slowly decrease it back to where it started.

An increase of insulin need of about 20% seems very doable.
I'm optimistic reading you needed to slowly decrease, I'm worrying about increasing my insulin only for it to suddenly be too much. But if the effect tapers off, I can taper off my increased insulin dose with it.

Having my diabetes go crazy for 7 days on the other hand sounds very stressful.

@Rachox and @grantg , I'm very happy to hear those injections only caused tiny blips in your diabetes for you, should I be offered the injections and decide to accept, I very much hope it will be the same for me!

 

[grantg]

should I be offered the injections and decide to accept, I very much hope it will be the same for me!

will keep fingers crossed gl feel free to let know if would like me to grab glucose report a few days prior for 30 days or whatever if that would be helpful. nb honeymoon period was lucky for much reduced insulin after that point of time.

 

[Westley]

I had a corticosteroid injection for a frozen shoulder a few years back. My insulin requirements definitely went up in the following weeks. Can't remember the exact numbers, but I think it was somewhere in the region of +30% for a couple of weeks then gradually drifted back to normal. It didn't make things more erratic though, and after adjusting dose it wasn't much trouble.

 

[Pipp]

Not on insulin, so not sure of relevance.
As a teenager , gymnast, dancer, I had juvenile arthritis. Knee pain for over a year . Cortisone injection caused swelling, and allergic reaction. No pain relief. I didn’t have diabetes then. Interestingly, some 50+ years later that knee joint is the only joint that doesn’t give me pain now.

Six years ago steroid injection in base of thumb. Similar allergic reaction. Blood glucose shot up into double figures for about two weeks, before gradually returning to normal over the next month.No pain reduction, but, physio and splints, hot wax bathing hand, helped, and I have learned to manage with limited movement snd pain meds.

As an aside, I was told that there is a limit to the number of steroid injections one can have in any joint. I think it was three. Apparently the efficacy diminishes each time. I won’t be having any more, mainly because the allergic reactions were unpleasant, but don’t let that putnyou off. I am allergic to lots of things.

Efficacy and safety of multiple intra-articular corticosteroid injections for osteoarthritis-a systematic review and meta-analysis of randomized controlled trials and observational studies - PubMed

Multiple IACS injections are no better than placebo for OA pain according to current evidence. The preliminary finding of a detrimental effect on structural OA progression warrants further investigation. Efficacy and safety of multiple IACS reflecting recommended best practice has yet to be...

pubmed.ncbi.nlm.nih.gov

 

[Melgar]

Not on insulin, so not sure of relevance.
As a teenager , gymnast, dancer, I had juvenile arthritis. Knee pain for over a year . Cortisone injection caused swelling, and allergic reaction. No pain relief. I didn’t have diabetes then. Interestingly, some 50+ years later that knee joint is the only joint that doesn’t give me pain now.

Six years ago steroid injection in base of thumb. Similar allergic reaction. Blood glucose shot up into double figures for about two weeks, before gradually returning to normal over the next month.No pain reduction, but, physio and splints, hot wax bathing hand, helped, and I have learned to manage with limited movement snd pain meds.

As an aside, I was told that there is a limit to the number of steroid injections one can have in any joint. I think it was three. Apparently the efficacy diminishes each time. I won’t be having any more, mainly because the allergic reactions were unpleasant, but don’t let that putnyou off. I am allergic to lots of things.

Efficacy and safety of multiple intra-articular corticosteroid injections for osteoarthritis-a systematic review and meta-analysis of randomized controlled trials and observational studies - PubMed

Multiple IACS injections are no better than placebo for OA pain according to current evidence. The preliminary finding of a detrimental effect on structural OA progression warrants further investigation. Efficacy and safety of multiple IACS reflecting recommended best practice has yet to be...

pubmed.ncbi.nlm.nih.gov

That is interesting to know @Pipp that cortisone injections in joints diminish their effectiveness with every shot. I’ll ask my Dr as mine will be in my spine.
With knees or hips one can get replacement joints. I dare say any joint barring the spine. It’s a long miserable journey of suffering of course, until such time Drs decide to replace the joint. I was told I would need knee replacements by the time I was 40 . I have had a number of operations on them to remove debris, mostly disintegrating cartilage, one was an emergency operation, and performed within 24hrs, when my left knee mechanically locked with excruciating pain.

@Antje77 maybe your specialist will suggest keyhole surgery to remove some debris from your knee joint. That’s what they did for me. I think I was around 33-34 when I had my first knee op. I’m holding out as it seems replacement joints last around 20 years with normal use.

My hip joints I’m guessing will be the first to be replaced.

 

[Zilsniggy]

I'm having an appointment with my rheumatologist next week. Last time I saw her was over a year ago, we couldn't pinpoint a diagnosis so we agreed on waiting and seeing until next year, which is now.

A year ago, she seemed very keen on giving me a steroid injection in my knee. The knee bothered me but not to the point I wanted to risk diabetes management becoming a nightmare with a steroid injection so I declined. She was also rather dismissive of my worries about the effects on diabetes, and I have a feeling she doesn't know much about diabetes, so she's not the right person to advise me on side effects for diabetics.

By now, my knee bothers me enough to wake me up multiple times a night, and the other knee is bothering me as well, to a lesser extent.
So in anticipation of my appointment, I want to learn more about steroid injections and diabetes in case she offers me again to be able to make an informed decision.

If any of you have had such injections, how did it affect your diabetes? All experiences are interesting to me, no matter if you're diet controlled or on insulin, so don't hesitate to reply if you have a different type of diabetes than I have!
I'm particularly interested in how long the effects on BG lasts. I can deal with a couple of days of diabetes misery, a week or longer is a different story.
If anyone has links to relevant studies, very welcome as well!

I also sent my endo a message, not sure if she'll have time to reply before my rheumatology appointment.

Thanks in advance!

There is evidence that steroid injections help with inflammation but unfortunately destroy cartilage. They will give relief for a short time, and then you will need another, whose effects will last an ever shorter period of time before you need the next one……see where I’m going with this? There are few actual studies to bear this out, but that doesn’t mean that it doesn’t happen. I would make the decision only after very serious consideration.

 

[Antje77]

There is evidence that steroid injections help with inflammation but unfortunately destroy cartilage. They will give relief for a short time, and then you will need another, whose effects will last an ever shorter period of time before you need the next one……see where I’m going with this? There are few actual studies to bear this out, but that doesn’t mean that it doesn’t happen. I would make the decision only after very serious consideration.

I did some googling today and I did find that pain relief lasts for 3 weeks on average. Why even do it?

On the other hand, @Rachox , @grantg , and @h884 all mentioned positive effects so I'm not sure yet. If I'm even offered the injection of course.

Three weeks of sleeping without pain in my knees sounds wonderful. But I'll still have the pain in my shoulders and neck to keep me awake, plus pesky Libre alarms thanks to the steroids.

 

[lovinglife]

Not my experience @Antje77 but my hubby had injection in his hip twice many years ago, first on last 3 or so years then he had a second one about 8 years ago & he’s never needed another

 

[Rachox]

I did some googling today and I did find that pain relief lasts for 3 weeks on average. Why even do it?

I was told months rather than weeks, I guess in practice it will vary from joint to joint and person to person. Mine lasted about four months but was treating something that eventually has healed itself so I haven’t had to have it repeated.

 

[Nicola M]

I've not had Steroid Injections, although I have taken steroid tablets and given that they're both steroids, the effects probably aren't that dissimilar. However, I know the injection can remain in your system for a longer period. The point being, though, it's tough to know how your body will react. My first set of steroid tablets, I rose for a few hours after taking them (up to about 16 mmol/mol), but then came steadily back down. My second set of tablets I rose into the high 20's, my pump couldn't cope, and I ended up having to give 20% more basal for the few hours after taking them for the duration of treatment. My experience, although not related to injection,s I think does show that our body can work in weird and wonderful ways and until you try something, you aren't fully going to know how it will affect you

 

[Antje77]

I also sent my endo a message, not sure if she'll have time to reply before my rheumatology appointment.

I absolutely love my endo!

She wrote me a reply this morning, looks like she took her time doing some research for me on top of sharing her own experiences with patients.
I'll share our complete conversation (translated by google, I'm lazy) for others to read if they are wondering about steroid injections as well. I don't want to change her words to give you a synopsis, and you'll get my half of the conversation so you'll know what questions prompted her reply.

I especially appreciate her not advising me on what to decide, or telling me how to handle my diabetes if I decide to take the injection. She really does understand me well.

I wrote:

"Dear Ilse,

I have an appointment with the rheumatologist on Thursday, November 27th (still undiagnosed). When I was there last year, she was very enthusiastic about the idea of giving me an injection in my right knee, although I still found the pain quite bearable.
I asked about the possible effects on my blood sugar/insulin needs, and she assumed it wouldn't be too bad. That's not the experience of some other diabetics, so I declined the injection, even after she offered a low dose. I don't expect a rheumatologist to know much about the continuous management of diabetes, so I don't have much confidence in her assessment of the side effects.

My knee has become much more painful since then, and the other knee as well. Given last year's experiences, I expect she'll offer me another injection. Could you tell me more about what effect you expect on my blood sugar/insulin needs if she offers an injection and if I accept it, and especially about how long that effect generally lasts?

Links to relevant professional literature are very welcome; my mind thrives on information overload.

Kind regards, and see you in February!

Antje"

She replied with:

"Dear Antje,

That's a valid question. I started typing that I definitely expect a spike, and that in my experience, it generally lasts about 3-4 days, during which you need extra insulin.
I dove into PubMed (where all the specialist literature is listed) and found a very recent article by Japanese authors.

https://www.painphysicianjournal.com/current/pdf?article=ODA2MA==&journal=172 (hope you can open it).

In short: an increase to ~18 mmol after the injection on the first day, and then the effect lasts for about 6-7 days after the injection. See the picture below. (You fall into the blue group (insulin use), which therefore has the most difficulty regulating blood sugar after such an injection, not entirely unexpected.)



Good luck with your decision! Greetings, Ilse"